BackgroundBlood pressure is relevant to the diagnosis and management of many medical, cardiovascular and critical diseases. The accuracy of many commonly used noninvasive blood pressure (NIBP) monitors and the accuracy of NIBP measurements in hypo‐ and hypertensive standing horses has not been determined.Hypothesis/ObjectivesThe objective of this study was to investigate the accuracy of an oscillometric BP monitor in standing horses before and during pharmacologically induced hyper‐ and hypotension and to compare results in standing and anesthetized horses.AnimalsEight standing mares from a research herd (SG) and eight anesthetized horses from a hospital population (AG).MethodsProspective experimental and observational studies. Invasive blood pressure (IBP) and NIBP, corrected to heart level, were measured simultaneously. In the SG hyper‐ and hypotension were induced by administration of phenylephrine (3 μg/kg/min IV for 15 minutes) and acepromazine (0.05 mg/kg IV), respectively. In the AG NIBP and IBP were recorded during regular hospital procedures.ResultsThere was a significant correlation between mean NIBP and IBP in standing (R = 0.88, P < .001) and anesthetized horses (R = 0.81, P < .001). The mean bias (lower, upper limit of agreement) was 16.4(−16.1, 48.9) mmHg for mean BP in the SG and 0.5(−22.3, 23.2) mmHg in the AG. The NIBP device was capable of identifying the increase and decrease in BP in all horses, but in the SG significant correlation between NIBP and IBP was only detected for the normotensive phase.Conclusion and Clinical ImportanceWhile the evaluated oscillometric BP device allowed estimation of BP and adequately differentiated marked trends, the accuracy and precision were low in standing horses.
TAP injections were easy to perform with both techniques in calf cadavers. The volume of injectate did not influence spread. The authors conclude that a combination of the two approaches is necessary, but perhaps not sufficient, to stain all of the nerves innervating the ventral abdominal wall. Further studies are required to refine the technique and evaluate its efficacy in preventing nociception in calves.
Background Veno-arterial extracorporeal membrane oxygenation therapy is a growing treatment modality for acute cardiorespiratory failure. Cardiac output monitoring during veno-arterial extracorporeal membrane oxygenation therapy remains challenging. This study aims to validate a new thermodilution technique during veno-arterial extracorporeal membrane oxygenation therapy using a pig model. Methods Sixteen healthy pigs were centrally cannulated for veno-arterial extracorporeal membrane oxygenation, and precision flow probes for blood flow assessment were placed on the pulmonary artery. After chest closure, cold boluses of 0.9% saline solution were injected into the extracorporeal membrane oxygenation circuit, right atrium, and right ventricle at different extracorporeal membrane oxygenation flows (4, 3, 2, 1 l/min). Rapid response thermistors in the extracorporeal membrane oxygenation circuit and pulmonary artery recorded the temperature change. After calculating catheter constants, the distributions of injection volumes passing each circuit were assessed and enabled calculation of pulmonary blood flow. Analysis of the exponential temperature decay allowed assessment of right ventricular function. Results Calculated blood flow correlated well with measured blood flow (r2 = 0.74, P < 0.001). Bias was −6 ml/min [95% CI ± 48 ml/min] with clinically acceptable limits of agreement (668 ml/min [95% CI ± 166 ml/min]). Percentage error varied with extracorporeal membrane oxygenation blood flow reductions, yielding an overall percentage error of 32.1% and a percentage error of 24.3% at low extracorporeal membrane oxygenation blood flows. Right ventricular ejection fraction was 17 [14 to 20.0]%. Extracorporeal membrane oxygenation flow reductions increased end-diastolic and end-systolic volumes with reductions in pulmonary vascular resistance. Central venous pressure and right ventricular ejection fractions remained unchanged. End-diastolic and end-systolic volumes correlated highly (r2 = 0.98, P < 0.001). Conclusions Adapted thermodilution allows reliable assessment of cardiac output and right ventricular behavior. During veno-arterial extracorporeal membrane oxygenation weaning, the right ventricle dilates even with stable function, possibly because of increased venous return. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
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